Why treat adolescent idiopathic scoliosis?

April 21, 2020 - by admin - in Adolescent Idiopathic Scoliosis, Bracing, Schroth Physiotherapy for Scoliosis, Scoliosis and Back Pain, Scoliosis and Exercise

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Physiotherapists who treat Adolescent Idiopathic Scoliosis

By Rosemary Marchese, Physiotherapist, Schroth and SEAS methods for Scoliosis


Why do we sometimes treat Adolescent Idiopathic Scoliosis with conservative therapy options? Treatment outcomes for Adolescent Idiopathic Scoliosis (AIS) is often focused on reduction or stabilisation of the Cobb angle measured on X-Ray. I have seen many patients and their families with a major focus on Cobb angle, and rightfully so. Surgeons talk about Cobb angle. General practitioners talk about Cobb angle. Physiotherapists and orthotists talk about Cobb angle. How can we then expect the focus of successful treatment outcomes to be anything other than a reduction in this measurement taken on X-Ray?

Why has Cobb angle been the focus of treatment for Adolescent Idiopathic Scoliosis?

We know that if a child with AIS enters adulthood with a curve over 30 degrees the chances of progression increase. This risk is heightened once the curve gets beyond 50 degrees. So, it’s understandable that Cobb angle plays a large part of the discussion when it comes to treatment goals. But with this focus it’s easy to lose sight of so many other important factors.<treat_adolescent_idiopathic_scoliosis>

What else should we remember?

Medicine is an art and a science . We rely on scientific evidence to support our decisions but also have to make the best clinical decision possible when the evidence doesn’t ‘fit’ or is lacking. This is a very important thing to remember when we treat AIS. It is one of the reasons why a Consensus paper was published by SOSORT (The International Society of Scoliosis Orthopaedic and Rehabilitation Treatment in 2005 to answer the question ‘Why do we treat AIS’? (1).

Goals of treatment

The consensus paper published by the expert team of Negrini et al and members of SOSORT in 2005 (1) was able to clarify that there is more to treating a patient with AIS than simply being focused on Cobb angle.

Some of the reasons that were considered important, and indeed valid reasons to treat a patient with AIS include:

  • Improvement or maintenance of aesthetics
  • Quality of life and disability
  • Back pain
  • Psychological well-being
  • Progression in Adulthood
  • Preventing or minimising the need for further treatment
  • Breathing function
  • Radiological and clinical improvements, such as Cobb angle and angle of trunk rotation.
  • Posture, balance and movement related outcomes (1).

What else does the research say about Adolescent Idiopathic Scoliosis?

Since this consensus paper was published by SOSORT in 2005,  more research has been published to support conservative therapy options for treatment of AIS. This includes research in regard to bracing and physiotherapeutic scoliosis specific exercises (PSSE) such as Schroth and the Scientific Exercise Approach to Scoliosis (SEAS) methods for scoliosis. Bracing now has stronger evidence thanks to the BrAIST trial by Weinstein et al (2). Schroth physiotherapy also now has stronger evidence supporting it thanks to research by multiple articles, including randomised controlled trials, providing higher level evidence for Schroth than we have had in the past (3-6).

My experience as a scoliosis physiotherapist 

Each patient I see has different goals for treatment outcomes. Some are heavily focused on Cobb angle while others are open to looking at other parts of the body. I focus on ‘treating the human, not just the spine’. Some people have a relatively small Cobb angle yet they have great asymmetry in regard to postural balance. In contrast, some patients have larger Cobb angles but more postural balance, particularly those with two balanced curves as opposed to one curve. Sometimes the first reason a parent will book an appointment is because the child has noticed pain, but that doesn’t happen all that often. Many adolescents with AIS don’t have pain.

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The Schroth Method

It’s important for me as a physiotherapist to spend the time in my initial consultation finding out what the goals of the child and the parents are. In this way I find out if we are all on the same page when it comes to scoliosis treatment goals. Goals can change but if we get off to a good start from the beginning, all agreeing on some pre-determined goals, I find it easier to achieve patient compliance with the Schroth physiotherapy I prescribe, as well as compliance with wearing their brace if prescribed.


References

  1. Negrini, S. Grivas, TB., Kotwicki, T., Maruyama T, Rigo, M., Rudolf Weis, H. and members of the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). (2006) Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis 1: 4. DOI: 10.1186/1748-7161-1-4

  2. Weinstein, S., Dolan, LA., Wright, JG., and Dobbs, MB. (2013). Effects of bracing in adolescents with idiopathic scoliosis. N Eng J Medicine. 369: 1512-1521
    DOI: 10.1056/NEJMoa1307337.


  3. Kuru, T., Yeldan, I., Dereli, EE., Ozdincler, AR., Dikici, F. and Colak, I. (2015). The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled trial. Clinical Rehabilitation. 30(2): 181-90. Doi: 10.1177/0269215515575745.

  4. Schreiber S, Parent EC, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis. 2015;10:24.

  5. Schreiber, S., Parent, E., Khodayari Moez, E., Hedden, DM., Hill, DL., Moreau, M., Lou, E., Watkins, EM., and Southon, SC. (2016). Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcome in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS ONE 11 (12): e0168746. Doi 10.1371/journal.pone.0168746.

  6. Schreiber, S., Parent, E., Hill, DL., Hedden, DM., Moreau, MJ. And Southon , SC. (2017). Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? – results form a randomized controlled trial – ‘SOSORT 2017 Award Winner’. Scoliosis and Spinal Disorders 12: 26.

  7. Schreiber, S., Parent, E., Hill, DL., Hedden, DM., Moreau, MJ. And Southon , SC. (2019). Patients with adolescent idiopathic scoliosis perceive positive improvements regardless of change in the Cobb angle – Results from a randomized controlled trial comparing a 6-month Schroth intervention added to standard care and standard care alone. ‘SOSORT 2018 Award Winner’. BMC Musculoskeletal Disorders. 20: 319.

 

 

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